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Crapnell RD, Dempsey NC, Sigley E, Tridente A, Banks CE. Electroanalytical point-of-care detection of gold standard and emerging cardiac biomarkers for stratification and monitoring in intensive care medicine - a review. Mikrochim Acta 2022; 189:142. [PMID: 35279780 PMCID: PMC8917829 DOI: 10.1007/s00604-022-05186-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/17/2022] [Indexed: 12/27/2022]
Abstract
Determination of specific cardiac biomarkers (CBs) during the diagnosis and management of adverse cardiovascular events such as acute myocardial infarction (AMI) has become commonplace in emergency department (ED), cardiology and many other ward settings. Cardiac troponins (cTnT and cTnI) and natriuretic peptides (BNP and NT-pro-BNP) are the preferred biomarkers in clinical practice for the diagnostic workup of AMI, acute coronary syndrome (ACS) and other types of myocardial ischaemia and heart failure (HF), while the roles and possible clinical applications of several other potential biomarkers continue to be evaluated and are the subject of several comprehensive reviews. The requirement for rapid, repeated testing of a small number of CBs in ED and cardiology patients has led to the development of point-of-care (PoC) technology to circumvent the need for remote and lengthy testing procedures in the hospital pathology laboratories. Electroanalytical sensing platforms have the potential to meet these requirements. This review aims firstly to reflect on the potential benefits of rapid CB testing in critically ill patients, a very distinct cohort of patients with deranged baseline levels of CBs. We summarise their source and clinical relevance and are the first to report the required analytical ranges for such technology to be of value in this patient cohort. Secondly, we review the current electrochemical approaches, including its sub-variants such as photoelectrochemical and electrochemiluminescence, for the determination of important CBs highlighting the various strategies used, namely the use of micro- and nanomaterials, to maximise the sensitivities and selectivities of such approaches. Finally, we consider the challenges that must be overcome to allow for the commercialisation of this technology and transition into intensive care medicine.
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Affiliation(s)
- Robert D Crapnell
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Nina C Dempsey
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK.
| | - Evelyn Sigley
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK
| | - Ascanio Tridente
- Intensive Care Unit, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, Prescot, L35 5DR, UK
| | - Craig E Banks
- Faculty of Science and Engineering, Manchester Metropolitan University, Chester Street, Manchester, M1 5GD, UK.
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Omland T, Prebensen C, Jonassen C, Svensson M, Berdal JE, Seljeflot I, Myhre PL. Soluble ST2 concentrations associate with in-hospital mortality and need for mechanical ventilation in unselected patients with COVID-19. Open Heart 2021; 8:openhrt-2021-001884. [PMID: 34933965 PMCID: PMC8692780 DOI: 10.1136/openhrt-2021-001884] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 01/28/2023] Open
Abstract
Objective Soluble ST2 (sST2) reflects inflammation, endothelial dysfunction and myocardial fibrosis, is produced in the lungs and is an established biomarker in heart failure. We sought to determine the role of sST2 in COVID-19 by assessing pathophysiological correlates and its association to in-hospital outcomes. Methods We enrolled 123 consecutive, hospitalised patients with COVID-19 in the prospective, observational COVID-19 MECH study. Biobank samples were collected at baseline, day 3 and day 9. The key exposure variable was sST2, and the outcome was ICU treatment with mechanical ventilation or in-hospital death. Results Concentrations of sST2 at baseline was median 48 (IQR 37–67) ng/mL, and 74% had elevated concentrations (>37.9 ng/mL). Higher baseline sST2 concentrations were associated with older age, male sex, white race, smoking, diabetes, hypertension and chronic kidney disease. Baseline sST2 also associated with the presence of SARS-CoV-2 viraemia, lower oxygen saturation, higher respiratory rate and increasing concentrations of biomarkers reflecting inflammation, thrombosis and cardiovascular disease. During the hospitalisation, 8 (7%) patients died and 27 (22%) survivors received intensive care unit (ICU) treatment. Baseline sST2 concentrations demonstrated a graded association with disease severity (median, IQR): medical ward 43 (36–59) ng/mL; ICU 67 (39–104) ng/mL and non-survivors 107 (72–116) ng/mL (p<0.001 for all comparisons). These associations persisted at day 3 and day 9. Conclusions sST2 concentrations associate with SARS-CoV-2 viraemia, hypoxaemia and concentrations of inflammatory and cardiovascular biomarkers. There was a robust association between baseline sST2 and disease severity that was independent of, and superior to, established risk factors. sST2 reflects key pathophysiology and may be a promising biomarker in COVID-19. Trial registration number NCT04314232.
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Affiliation(s)
- Torbjorn Omland
- Department of Cardiology, Akershus University Hospital, Lorenskog, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christian Prebensen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Akershus University Hospital, Lorenskog, Norway
| | | | - My Svensson
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Jan Erik Berdal
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Akershus University Hospital, Lorenskog, Norway
| | - Ingebjørg Seljeflot
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Peder Langeland Myhre
- Department of Cardiology, Akershus University Hospital, Lorenskog, Norway .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Ruiz-Castilla M, Dos Santos B, Vizcaíno C, Baena J, Guilabert P, Marin-Corral J, Masclans JR, Roca O, Barret JP. Soluble suppression of tumorigenicity-2 predicts pneumonia in patients with inhalation injury: Results of a pilot study. Burns 2020; 47:906-913. [PMID: 33143991 DOI: 10.1016/j.burns.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/25/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Several mechanisms play a role in the development of pneumonia after inhalation injury. Our aim was to analyze whether higher concentrations of inflammatory markers or of biomarkers of epithelial injury are associated with a higher incidence of pneumonia in patients with inhalation injury. MATERIAL AND METHODS Secondary analysis of a single-center prospective observational cohort pilot study, performed over a two-year period (2015-2017) at the Burns Unit of the Plastic and Reconstructive Surgery Department of Vall d'Hebron University Hospital. All patients aged 18 with suspected inhalation injury undergoing admission to the Burns Unit were included. Plasma biomarkers of the lung epithelium (RAGE and SP-D), inflammation markers (IL6, IL8), and IL33, as well as soluble suppression of tumorigenicity-2 (sST2) levels, were measured within the first 24 h of admission. RESULTS Twenty-four patients with inhalation injury were included. Eight (33.3%) developed pneumonia after a median of 7 (4-8) days of hospital stay. Patients with pneumonia presented higher plasma concentrations of sST2 (2853 [2356-3351] ng/mL vs 1352 [865-1839] ng/mL; p < 0.001), IL33 (1.95 [1.31-2.59] pg/mL vs 1.26 [1.07-1.45] pg/mL; p = 0.002) and IL8 (325.7 [221.6-430.0] pg/mL vs 174.1 [95.2-253.0] pg/mL; p = 0.017) on day 1 of inclusion. Plasma sST2 concentration in the first 24 h demonstrated excellent diagnostic accuracy for predicting the occurrence of pneumonia in patients with smoke inhalation (AUROC 0.929 [95%CI 0.818-1.000]). A cutoff point of ≥2825 ng/mL for sST2 had a sensitivity of 75% and a specificity of 100%. The risk ratio of pneumonia in patients with sST2 ≥ 2825 ng/mL was 7.14 ([95% CI 1.56-32.61]; p = 0.016). CONCLUSIONS Plasma sST2 in the first 24 h of admission predicts the occurrence of pneumonia in patients with inhalation injury.
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Affiliation(s)
- Mireia Ruiz-Castilla
- Plastic and Reconstructive Surgery Department, Hospital Quirónsalud Barcelona, Barcelona, Spain; Plastic and Reconstructive Surgery Department and Burns Unit, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain.
| | - Bruce Dos Santos
- Plastic and Reconstructive Surgery Department and Burns Unit, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Claudia Vizcaíno
- Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jacinto Baena
- Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Patricia Guilabert
- Anesthesiology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Judith Marin-Corral
- Critical Care Department, Parc de Salut Mar (Hospital del Mar) de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Joan R Masclans
- Critical Care Department, Parc de Salut Mar (Hospital del Mar) de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Ciber Enfermedades Respiratorias (Ciberes), Instituto de Salud Carlos III, Madrid, Spain
| | - Oriol Roca
- Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain; Ciber Enfermedades Respiratorias (Ciberes), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan P Barret
- Plastic and Reconstructive Surgery Department and Burns Unit, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
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Green MD, Parker DM, Everett AD, Vricella L, Jacobs ML, Jacobs JP, Brown JR. Cardiac Biomarkers Associated With Hospital Length of Stay After Pediatric Congenital Heart Surgery. Ann Thorac Surg 2020; 112:632-637. [PMID: 32853571 DOI: 10.1016/j.athoracsur.2020.06.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Prolonged hospital length of stay after congenital heart surgery is a significant cost burden and is associated with postoperative morbidity. Our goal was to evaluate the association between pre- and postoperative biomarker levels and in-hospital length of stay for children after congenital heart surgery. METHODS We enrolled patients <18 years of age who underwent at least 1 congenital heart operation at Johns Hopkins Hospital from 2010 to 2014. Blood samples were collected before the index operation and at the end of the bypass. ST2 and N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements were evaluated as log-transformed, median, and tercile cut-points. We evaluated the association between pre- and postoperative NT-proBNP and ST2 measurements with in-hospital postoperative length of stay using multivariate logistic regression. We adjusted for covariates used in The Society of Thoracic Surgeons Congenital Heart Surgery Mortality Risk Model. RESULTS In our cohort 45% of our patients had an in-hospital postoperative length of stay longer than the median. Before adjustment preoperative NT-proBNP above the population median and the highest tercile exhibited a significantly longer in-hospital length of stay. After adjustment for covariates in the risk model, pre- and postoperative ST2 and NT-proBNP demonstrated a significantly longer length of stay. CONCLUSIONS Perioperative ST2 and NT-proBNP had a significant association with increased postoperative in-hospital length of stay before and after adjustment. ST2 in particular could be used to guide an earlier assessment of patient risk for complications that may lead to adverse outcomes.
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Affiliation(s)
- Michael D Green
- Department of Epidemiology, Geisel School of Medicine, Lebanon, New Hampshire.
| | - Devin M Parker
- Department of Epidemiology, Geisel School of Medicine, Lebanon, New Hampshire
| | - Allen D Everett
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luca Vricella
- Division of Pediatric Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marshall L Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida
| | - Jeffrey P Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida
| | - Jeremiah R Brown
- Department of Epidemiology, Geisel School of Medicine, Lebanon, New Hampshire; Department of Biomedical Data Science, Geisel School of Medicine, Lebanon, New Hampshire
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Peres IT, Hamacher S, Oliveira FLC, Thomé AMT, Bozza FA. What factors predict length of stay in the intensive care unit? Systematic review and meta-analysis. J Crit Care 2020; 60:183-194. [PMID: 32841815 DOI: 10.1016/j.jcrc.2020.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/02/2020] [Accepted: 08/02/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Studies have shown that a small percentage of ICU patients have prolonged length of stay (LoS) and account for a large proportion of resource use. Therefore, the identification of prolonged stay patients can improve unit efficiency. In this study, we performed a systematic review and meta-analysis to understand the risk factors of ICU LoS. MATERIALS AND METHODS We searched MEDLINE, Embase and Scopus databases from inception to November 2018. The searching process focused on papers presenting risk factors of ICU LoS. A meta-analysis was performed for studies reporting appropriate statistics. RESULTS From 6906 citations, 113 met the eligibility criteria and were reviewed. A meta-analysis was performed for six factors from 28 papers and concluded that patients with mechanical ventilation, hypomagnesemia, delirium, and malnutrition tend to have longer stay, and that age and gender were not significant factors. CONCLUSIONS This work suggested a list of risk factors that should be considered in prediction models for ICU LoS, as follows: severity scores, mechanical ventilation, hypomagnesemia, delirium, malnutrition, infection, trauma, red blood cells, and PaO2:FiO2. Our findings can be used by prediction models to improve their predictive capacity of prolonged stay patients, assisting in resource allocation, quality improvement actions, and benchmarking analysis.
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Affiliation(s)
- Igor Tona Peres
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | | - Antônio Márcio Tavares Thomé
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Fernando Augusto Bozza
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil; IDOR, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.
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Lyngbakken MN, Myhre PL, Røsjø H, Omland T. Novel biomarkers of cardiovascular disease: Applications in clinical practice. Crit Rev Clin Lab Sci 2018; 56:33-60. [DOI: 10.1080/10408363.2018.1525335] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Magnus Nakrem Lyngbakken
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Peder Langeland Myhre
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Center for Heart Failure Research, University of Oslo, Oslo, Norway
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Meta-Analysis of Soluble Suppression of Tumorigenicity-2 and Prognosis in Acute Heart Failure. JACC-HEART FAILURE 2017; 5:287-296. [DOI: 10.1016/j.jchf.2016.12.016] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/31/2016] [Accepted: 12/29/2016] [Indexed: 11/23/2022]
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Aimo A, Vergaro G, Passino C, Ripoli A, Ky B, Miller WL, Bayes-Genis A, Anand I, Januzzi JL, Emdin M. Prognostic Value of Soluble Suppression of Tumorigenicity-2 in Chronic Heart Failure. JACC-HEART FAILURE 2017; 5:280-286. [DOI: 10.1016/j.jchf.2016.09.010] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/07/2016] [Accepted: 09/14/2016] [Indexed: 11/27/2022]
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